Provider Demographics
NPI:1639576333
Name:HAWKINS, CHASITY LEANNE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CHASITY
Middle Name:LEANNE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6063
Mailing Address - Country:US
Mailing Address - Phone:575-257-2368
Mailing Address - Fax:575-257-2141
Practice Address - Street 1:237 SERVICE RD
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6063
Practice Address - Country:US
Practice Address - Phone:575-257-2368
Practice Address - Fax:575-257-2141
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3616451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM850441031Medicaid